Hundreds of foreign doctors close to finishing their training in the U.S. may face mandatory departure if their visa waiver applications are not processed promptly by the federal government. Immigration attorneys have expressed concerns about these delays, which have persisted since last fall and winter.
The waiver program, overseen by the Department of Health and Human Services (HHS), allows non-U.S. citizens to remain in the country while transitioning from their training visas to temporary work status. In return, these doctors commit to serving in underserved areas for at least three years.
“The biggest impact will be on the patients, as many health facilities may soon be without a physician,” noted a psychiatrist who is waiting on the application process.
This psychiatrist, who requested not to be named to avoid potential repercussions, is one of many who applied this year for a J-1 visa waiver through the HHS Exchange Visitor Program. If successful, they would work with vulnerable patients in New York.
Historically, HHS has reviewed waiver applications within one to three weeks. However, the current backlog has left many applications in limbo, needing clearance from the State Department and U.S. Citizenship and Immigration Services (USCIS), according to several attorneys who discussed the situation.
Many foreign doctors may have to return home if their application doesn’t progress by the July 30 deadline. If they want to come back to the U.S., their employers would need to pay a new $100,000 fee associated with the H-1B work visa—an expense that many rural and smaller hospitals cannot afford. “It’s alarming to see this situation unfold,” commented immigration lawyer Charles Wintersteen from Chicago.
HHS representatives did not provide information on the number of pending applications or the reasons for the delays. However, they stated they are implementing process improvements to avoid future backlogs and are working diligently to clear pending applications before the July deadline.
The psychiatrist emphasized that hospitals hiring J-1 waiver physicians must show they couldn’t find American workers for the roles. If the expected doctors can’t arrive, patients will face even longer wait times for care, they noted.
According to Wintersteen, Medicare primarily funds postgraduate medical education, meaning taxpayers who support this training are not seeing the benefits.
Medical professionals and immigration lawyers have pointed out that HHS hasn’t provided adequate explanations for the delays. Virginia-based immigration lawyer Jennifer Minear highlighted the baffling nature of slowing down a functioning program that places trained physicians in areas lacking sufficient healthcare.
Uncertainty in the Waiver Process
The U.S. healthcare system critically relies on foreign-born professionals, particularly in underserved rural and urban communities. Nearly 25% of U.S. physicians studied medicine abroad.
After completing their postgraduate training in the U.S., noncitizens typically must return home for two years before applying for an H-1B visa. Alternatively, they can pursue a J-1 waiver, allowing them to stay in the U.S. on H-1B status by committing to work in shortage areas for three years.
Currently, the Exchange Visitor Program seems to be experiencing only delays in processing J-1 waivers, while other federal or state programs continue on schedule.
Last year, the HHS clinical care program received 750 waiver applications, primarily benefiting doctors in pediatrics, psychiatry, and family medicine. Traditionally, these applications are sent for State Department review by mid-March; however, processing appears to have stalled.
Minear noted that applications ceased to be processed around late September into early October, but have resumed at a much slower pace.
According to standard procedure, the State Department needs a couple of months to evaluate applications and send them to USCIS for final approval before the critical July 30 deadline. If applications aren’t submitted on time, Wintersteen warned, the doctors will likely be forced to leave the U.S. unless they can find alternative visa solutions.
The psychiatrist, preparing to start work on July 1, shared their desire to stay in the U.S. to serve vulnerable populations such as survivors of trafficking and the homeless. “That’s the community I want to work with,” they expressed.
Challenges with H-1B Visa Fees
In 2020, a proclamation by then-President Trump targeted H-1B visas, imposing a $100,000 fee for foreign workers in all fields, not just tech-related jobs. This fee does not apply to those already residing in the U.S.
Employers from different sectors have paid this fee for a small portion of workers, but it remains uncertain how many were for medical professionals.
The psychiatrist mentioned that the hiring hospital indicated it couldn’t afford the cost to bring them back if they were forced to return home. “Many hospitals that hire J-1 waiver physicians operate in low-income areas and treat patients on Medicare or Medicaid,” they noted. “These are not wealthy institutions.”
Additional legal expenses for recruiting and applying for waivers highlight the financial strain on hospitals. Barry Walker, an immigration lawyer, stated that the H-1B fee is particularly burdensome for small, rural hospitals.
Typically, employers are more willing to sponsor H-1B visas for physicians in lucrative specialties, like cardiology, but are less likely to do so for nurses and technicians who often complete training outside the U.S.
Employers can ask for fee exemptions but reports suggest no facility has successfully received one.
Joint Efforts to Address Challenges
In response to the ongoing waiver delays at HHS, various stakeholders, including hospital leaders and lawmakers, are advocating for solutions. Hospitals and medical organizations have requested exceptions to the $100,000 fee for healthcare workers.
A bipartisan bill was introduced in March to create a healthcare exemption, though it has yet to be discussed in hearings. Several lawsuits are also in motion to challenge the fee and its implications.
The American Medical Association CEO has urged the Exchange Visitor Program to adopt “emergency batch processing” for physicians whose contracts start as soon as this summer.
Efrén Manjarrez, president of the Society of Hospital Medicine, echoed this sentiment, noting that every day of delay adds to the risk for hospitalized patients in these communities.
Meanwhile, Canadian hospitals are actively recruiting foreign physicians finishing their U.S. training, leading some to accept positions elsewhere and withdraw their waiver applications.
As for the psychiatrist awaiting processing, leaving the U.S. could mean months without work and separation from their partner. Even if financial conditions allowed for their return, they expressed doubts about doing so, stating, “This whole process has been incredibly painful. I’d rather contribute to a system that appreciates my dedication to patient care.”
